Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settings

OBJECTIVE: To describe the electronic medical databases used in antiretroviral therapy (ART) programmes in lower-income countries and assess the measures such programmes employ to maintain and improve data quality and reduce the loss of patients to follow-up. METHODS: In 15 countries of Africa, South America and Asia, a survey was conducted from December 2006 to February 2007 on the use of electronic medical record systems in ART programmes. Patients enrolled in the sites at the time of the survey but not seen during the previous 12 months were considered lost to follow-up. The quality of the data was assessed by computing the percentage of missing key variables (age, sex, clinical stage of HIV infection, CD4+ lymphocyte count and year of ART initiation). Associations between site characteristics (such as number of staff members dedicated to data management), measures to reduce loss to follow-up (such as the presence of staff dedicated to tracing patients) and data quality and loss to follow-up were analysed using multivariate logit models. FINDINGS: Twenty-one sites that together provided ART to 50 060 patients were included (median number of patients per site: 1000; interquartile range, IQR: 72-19 320). Eighteen sites (86%) used an electronic database for medical record-keeping; 15 (83%) such sites relied on software intended for personal or small business use. The median percentage of missing data for key variables per site was 10.9% (IQR: 2.0-18.9%) and declined with training in data management (odds ratio, OR: 0.58; 95% confidence interval, CI: 0.37-0.90) and weekly hours spent by a clerk on the database per 100 patients on ART (OR: 0.95; 95% CI: 0.90-0.99). About 10 weekly hours per 100 patients on ART were required to reduce missing data for key variables to below 10%. The median percentage of patients lost to follow-up 1 year after starting ART was 8.5% (IQR: 4.2-19.7%). Strategies to reduce loss to follow-up included outreach teams, community-based organizations and checking death registry data. Implementation of all three strategies substantially reduced losses to follow-up (OR: 0.17; 95% CI: 0.15-0.20). CONCLUSION: The quality of the data collected and the retention of patients in ART treatment programmes are unsatisfactory for many sites involved in the scale-up of ART in resource-limited settings, mainly because of insufficient staff trained to manage data and trace patients lost to follow-up.

Das Internet der Dinge unter dem Aspekt der Selbststeuerung-Ein Überblick

In den letzten Jahren wurde die Vision einer Welt smarter Alltagsgegenstände unter den Begriffen wie Ubiquitous Computing, Pervasive Computing und Ambient Intelligence in der Öffentlichkeit wahrgenommen. Die smarten Gegenstände sollen mit digitaler Logik, Sensorik und der Möglichkeit zur Vernetzung ausgestattet werden. Somit bilden sie ein „Internet der Dinge“, in dem der Computer als eigenständiges Gerät verschwindet und in den Objekten der physischen Welt aufgeht. Während auf der einen Seite die Vision des „Internet der Dinge“ durch die weiter anhaltenden Fortschritte in der Informatik, Mikroelektronik, Kommunikationstechnik und Materialwissenschaft zumindest aus technischer Sicht wahrscheinlich mittelfristig realisiert werden kann, müssen auf der anderen Seite die damit zusammenhängenden ökonomischen, rechtlichen und sozialen Fragen geklärt werden. Zur Weiterentwicklung und Realisierung der Vision des „Internet der Dinge“ wurde erstmals vom AutoID-Center das EPC-Konzept entwickelt, welches auf globale netzbasierte Informationsstandards setzt und heute von EPCglobal weiterentwickelt und umgesetzt wird. Der EPC erlaubt es, umfassende Produktinformationen über das Internet zur Verfügung zu stellen. Die RFID-Technologie stellt dabei die wichtigste Grundlage des „Internet der Dinge“ dar, da sie die Brücke zwischen der physischen Welt der Produkte und der virtuellen Welt der digitalen Daten schlägt. Die Objekte, die mit RFID-Transpondern ausgestattet sind, können miteinander kommunizieren und beispielsweise ihren Weg durch die Prozesskette finden. So können sie dann mit Hilfe der auf den RFID-Transpondern gespeicherten Informationen Förderanlagen oder sonstige Maschinen ohne menschliches Eingreifen selbstständig steuern.

Wearable Computing und RFID in Produktion und Logistik – Ansätze zur bereichsübergreifenden Nutzung digitaler Informationen

Die voranschreitende Entwicklung von Konzepten und Systemen zur Nutzung digitaler Informationen im industriellen Umfeld eröffnet verschiedenste Möglichkeiten zur Optimierung der Informationsverarbeitung und damit der Prozesseffektivität und -effizienz. Werden die relevanten Daten zu Produkten oder Prozessen jedoch lediglich in digitaler Form zur Verfügung gestellt, fällt ein Eingriff des Menschen in die virtuelle Welt immer schwerer. Auf Grundlage dessen wird am Beispiel der RFIDTechnologie dargestellt, inwiefern digitale Informationen durch die Verwendung von in den Arbeitsablauf integrierten Systemen für den Menschen nutzbar werden. Durch die Entwicklung eines Systems zur papierlosen Produktion und Logistik werden exemplarisch Einsatzszenarien zur Unterstützung des Mitarbeiters in Montageprozessen sowie zur Vermeidung von Fehlern in der Kommissionierung aufgezeigt. Dazu findet neben einer am Kopf getragenen Datenbrille zur Visualisierung der Informationen ein mobiles RFID-Lesegerät Anwendung, mit Hilfe dessen die digitalen Transponderdaten ohne zusätzlichen Aufwand für den Anwender genutzt werden können.

Improving Management of Distributed Services Using Correlations and Predictions in SLA-Driven Cloud Computing Systems

Recent advancements in cloud computing have enabled the proliferation of distributed applications, which require management and control of multiple services. However, without an efficient mechanism for scaling services in response to changing environmental conditions and number of users, application performance might suffer, leading to Service Level Agreement (SLA) violations and inefficient use of hardware resources. We introduce a system for controlling the complexity of scaling applications composed of multiple services using mechanisms based on fulfillment of SLAs. We present how service monitoring information can be used in conjunction with service level objectives, predictions, and correlations between performance indicators for optimizing the allocation of services belonging to distributed applications. We validate our models using experiments and simulations involving a distributed enterprise information system. We show how discovering correlations between application performance indicators can be used as a basis for creating refined service level objectives, which can then be used for scaling the application and improving the overall application's performance under similar conditions.

Linked services for M2M communication with Enterprise IT systems

Linking the physical world to the Internet, also known as the Internet of Things, has increased available information and services in everyday life and in the Enterprise world. In Enterprise IT an increasing number of communication is done between IT backend systems and small IoT devices, for example sensor networks or RFID readers. This introduces some challenges in terms of complexity and integration. We are working on the integration of IoT devices into Enterprise IT by leveraging SOA techniques and Semantic Web technologies. We present a SOA based integration platform for connecting WSNs and large enterprise business processes. For ensuring interoperability our platform is based on Linked Services. These are thoroughly described, machine-readable, machine-reasonable service descriptions.

Influence of manure scrapers on dairy cows in cubicle housing systems

Manure scrapers are widely used in dairy cow loose-housing systems. In order to evaluate the effects of the scrapers on the cows, we assessed their impact on the animals' cardiac activity, feeding behaviour, and the behavioural reactions of cows confronted with different types of scrapers. In part I of the study, we measured cardiac activity (mean R–R interval and RMSSD, a parameter of heart-rate variability) whilst observing the behaviour of 29 focal cows on three farms during situations with and without active manure scrapers. Lower RMSSD values were observed during scraping events while cows were either lying, standing or walking in the alleyway, standing completely in the lying cubicle, or standing half in the lying cubicle (P=0.03), but only tended to differ while directly confronted with the scraper (P=0.06). This indicates that dairy cows experienced at least some mild stress during manure-scraping events. In part II, the feeding behaviour of 12 cows on each of two farms was recorded by means of a jaw-movement sensor and compared between situations with the manure-scraping event following forage provision either within or outside the main daily feeding period (i.e. within 1 or after 2 h from forage provisioning, respectively). The duration of night-time feeding (P=0.049) and the number of feeding bouts (P=0.036) were higher when a manure-scraping event took place within the main daily feeding period, indicating that the cows' feeding behaviour had been disturbed. In part III, we observed the cows' behaviour on 15 farms during eight manure scraping events per farm, where each of five farms had one of three different scraper types. We assessed the cows' immediate reactions when confronted with the scraper. In addition, we recorded the number of animals present in the alleyways before and after the manure-scraping events. The more cows that were present in the alleyways before the scraping event, the lower the proportion of cows showing direct behavioural reactions both with (P=0.017) and without (P=0.028) scraper contact, and the higher the number of cows that left the alleyways (P<0.001). Scraper type did not influence the proportion of cows showing behavioural reactions. In conclusion, our results show that dairy cows perceive the manure-scraping event negatively in some situations, that feeding behaviour may be disturbed when scrapers are active during the main feeding period, and that cows avoid the scraper during crowded situations.

New Patterns of Democracy in the Countries of the Comparative Study of Electoral Systems

The chapter introduces a new database on political-institutional patterns of democracy used in the contributions to the book. It provides an update and extension of Lijphart’s (1999, 2012) measurement of consensus and majoritarian democracy for the countries of the second wave of the CSES during the period 1997–2006, using 11 partly improved indicators. The chapter explores patterns of democracy by the means of factor analysis, construct additive indices, and present the resulting country scores of consensus and majoritarian democracy graphically. Two variants are presented, one featuring Lijphart’s (1999) classic ‘executives–parties’ and ‘federal–unitary’ dimensions, and another incorporating direct democracy into the framework, yielding an additional ‘cabinets–direct democracy’ dimension

When the systems fail to communicate. Cerebral resting state networks in schizophrenia spectrum disorders.

There have been numerous attempts to reveal the neurobiological basis of schizophrenia spectrum disorders. Results however, remain as heterogeneous as the schizophrenia spectrum disorders itself. Therefore, one aim of this thesis was to divide patients affected by this disorder into subgroups in order to homogenize the results of future studies. In a first study it is suggested that psychopathological rating scales should focus on symptoms-clusters that may have a common neurophysiological background. The here presented Bern Psychopathology Scale (BPS) proposes that alterations in three wellknown brain systems (motor, language, and affective) are largely leading to the communication failures observable on a behavioral level, but also - as repeatedly hypothesized - to dysconnectivity within and between brain systems in schizophrenia spectrum disorders. The external validity of the motor domain in the BPS was tested against the objective measure of 24 hours wrist actigraphy, in a second study. The subjective, the quantitative, as well as the global rating of the degree of motor disorders in this patient group showed significant correlations to the acquired motor activity. This result confirmed in a first step the practicability of the motor domain of the BPS, but needs further validation regarding pathological brain alterations. Finally, in a third study (independent from the two other studies), two cerebral Resting State Networks frequently altered in schizophrenia were investigated for the first time using simultaneous EEG/fMRI: The well-known default mode network and the left working memory network. Besides the changes in these fMRI-based networks, there are well-documented findings that patients exhibit alterations in EEG spectra compared to healthy controls. However, only through the multimodal approach it was possible to discover that patients with schizophrenia spectrum disorders have a slower driving frequency of the Resting State Networks compared to the matched healthy controls. Such a dysfunctional coupling between neuronal frequency and functional brain organization could explain in a uni- or multifactorial way (dysfunctional cross-frequency coupling, maturational effects, vigilance fluctuations, task-related suppression), how the typical psychotic symptoms might occur. To conclude, the major contributions presented in this thesis were on one hand the development of a psychopathology rating scale that is based on the assumption of dysfunctional brain networks, as well as the new evidence of a dysfunctional triggering frequency of Resting State Networks from the simultaneous EEG/fMRI study in patients affected by a schizophrenia spectrum disorder.